The number of uninsured and underinsured Americans continues to rise. Many large U.S. corporations are finding the burden of providing health insurance for their retirees, as well as their workers, seriously affecting their ability to compete globally. Many smaller companies are eliminating their health insurance entirely, or requiring greater contributions on the part of the insured worker. The problems encountered by industry have resulted in a new form of health insurance called Consumer-Driven Health Plans, which require greater outlays by covered workers. The changes in our health care delivery system in the past 42 years have dramatically changed the practice of optometry as well as medicine. The rapid growth in health care costs, particularly for our citizens who pay for their own health insurance, has outpaced wages by nearly 4 times. The number of citizens who qualify for Medicaid continues to increase. This presents a particular problem for optometry, as vision care is not a mandated service of Medicaid under federal guidelines. In addition, many managed care plans may have to eliminate eye care benefits, which are often a carve-out of a major plan in order to stay competitive. There is also evidence to suggest that many of our citizens who can least afford the present cost of health care will attempt to receive their care from community clinics and charitable programs, including vision care programs.